UGSA Surgical Treatment of SUI Pathway 2016

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SUI Surgery Pathway

SUI Surgery Pathway

	Bothersome SUI not responding to conservative treatment


Colposuspension	Mid-Urethral sling	Pubovaginal sling


Mini-sling	Retropubic tape	Obturator tape

Preferred Option

Possible Pathway

Further Data Required

Surgical Treatment Female Stress Urinary Incontinence
Those with complicated incontinence (recurrent, post radiation, fixed urethra) need individualised care.	GoR

Surgical Options Colposuspension

Superior outcomes to anterior repair, MMK and needle suspensions	A
Similar outcomes to pubovaginal slings with less morbidity	B
Outcomes similar or slightly less than synthetic Mid Urethral Slings (MUS) however longer operating time and recovery, slower return to activities of daily living and more prolapse in medium term	B
Laparoscopic approach when performed same technique as open has similar success rate with less morbidity than open approach	B
Consider in those wishing to avoid mesh procedure

Surgical Options Pubovaginal sling

Limited data comparing to MUS	B
Demonstrated similar outcomes however pubovaginal sling greater lower urinary tract symptoms and reoperation than MUS. The MUS had higher rate of bladder perforation	B
When compared to colposuspension outcomes similar except higher voiding dysfunction following pubovaginal slings	B
Consider in those wishing to avoid mesh procedure

Surgical Options Mid-urethral sling
Recommended surgical treatment female SUI	A
The most extensively researched option for SUI establishing efficacy and safety profile	A
As effective or more effective than colposuspension or pubovaginal sling with less perioperative and post-operative morbidity	B
Include retropubic, transobturator or minislings

Mini-slings
Many of these products removed from the market by manufacturers	C
Very limited data on outcomes of those that remain on the market	C
Until further data available consider use in audit environment with ethics committee oversight	C

Retropubic versus transobturator mid-urethral sling

In short-term retropubic and obturator tapes have similar outcomes with the obturator tape being slightly quicker to perform (few minutes quicker).	A
However in the medium term (>5 years) the reoperation for recurrent SUI greater in obturator group and a small number develop groin pain (3-4%) that is difficult to treat.	A
Retropubic considered as the preferred procedure with transobturator reserved for those patients with a hostile abdomen and in those at increased risk of bleeding (medications such as asprin or warfarin).	C

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